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All men with ED should consult their doctor before obtaining erectile dysfunction medication online. Viagra works by increasing blood flow to the penis which helps men get and sustain an erection long enough for sex. Sildenafil inhibits blocks an enzyme which regulates blood flow in the penis. PDE5 inhibitors multiply the natural process of arousal and increase blood flow to the penis in situations of sexual stimulation. Sildenafil helps to achieve an erection but relies on natural arousal as a trigger. The usual first starting dose of Viagra is one 50mg tablet, for men who have not used it before, although men over the age of 65 years would normally start on the lowest dose tablet 25mg.